Journal of Anesthesia

, Volume 27, Issue 2, pp 218–223

Analysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia

  • Sung-Jin Hong
  • Yoo-Jin Kang
  • Young-Hun Jeon
  • Ji-Seon Son
  • Jang-Ho Song
  • Chan-Seon Yoo
  • Duk-Kyung Kim
Original Article

Abstract

Purpose

Procedural sedation during diagnostic or therapeutic procedures is currently widely used by clinicians across a broad range of specialties. However, procedural sedation is a poorly controlled practice in many countries, often performed in potentially unsafe environments.

Methods

In 2009, the Legislation Committee of the Korean Society of Anesthesiologists, based on expert consultation referrals provided by police departments, civil courts, and criminal courts, initiated the construction of database to compile all anesthesia-related adverse events. Using this database (July 2009 to April 2012), we have compared causative mechanisms and injury patterns in procedural sedation (Sedation) cases (N = 25) with those in general anesthesia (GA) cases (N = 29).

Results

The severity of injury in Sedation cases was similar to that in GA cases, with death occurring in 72.0 % of cases. Hypoxia secondary to airway obstruction or respiratory depression was the most common specific mechanism of Sedation-related injuries (64.0 %). In-depth analysis of pre-procedural evaluation and intraoperative monitoring revealed a common lack of vigilance in the Sedation cases, and most injuries were judged as preventable with better monitoring. Non-anesthesiologist administration of propofol (NAAP) was performed in the great majority of Sedation cases (88.0 %).

Conclusion

Our analysis of procedural sedation based on anesthesia-related adverse events compiled in the national database revealed a high severity of patient injury similar to that due to general anesthesia. Most procedural sedations were shown to be poorly controlled without adequate pre-procedural patient evaluation or intraoperative monitoring. Thus, it is essential to establish proper practical guidelines for procedural sedation and ensure strict adherence to these guidelines, especially during the NAAP.

Keywords

Deep sedation Injuries Malpractice Propofol 

References

  1. 1.
    Lee KH, An TH, Choi JH, Lim DG, Lee YJ, Kim DK. Analysis of expert consultation referrals for anesthesia-related issues (December 2008–July 2010): KSA legislation committee report. Korean J Anesthesiol. 2011;60:260–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104:228–34.PubMedCrossRefGoogle Scholar
  3. 3.
    American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–17.Google Scholar
  4. 4.
    Green SM, Krauss B. Procedural sedation terminology: moving beyond “conscious sedation”. Ann Emerg Med. 2002;39:433–5.PubMedCrossRefGoogle Scholar
  5. 5.
    American Society of Anesthesiology. Distinguishing monitored anesthesia care (“MAC”) from moderate sedation/analgesia (conscious sedation). Available at: http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx. Accessed 4 Sept 2012.
  6. 6.
    Perel A. Non-anaesthesiologists should not be allowed to administer propofol for procedural sedation: a Consensus Statement of 21 European National Societies of Anaesthesia. Eur J Anaesthesiol. 2011;28:580–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Hug CC Jr. MAC should stand for maximum anesthesia caution, not minimal anesthesiology care. Anesthesiology. 2006;104:221–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, Moore J, American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45:177–96.PubMedCrossRefGoogle Scholar
  9. 9.
    Standards of Practice Committee of the American Society of Gastrointestinal endoscopy, Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan SI, Harrison ME, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008;68:815–26.PubMedCrossRefGoogle Scholar
  10. 10.
    Iverson RE. Sedation and analgesia in ambulatory settings. American Society of Plastic and Reconstructive Surgeons. Task Force on Sedation and Analgesia in Ambulatory Settings. Plast Reconstr Surg. 1999;104:1559–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Eichhorn V, Henzler D, Murphy MF. Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room. Curr Opin Anaesthesiol. 2010;23:494–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Downs JB. Has oxygen administration delayed appropriate respiratory care? Fallacies regarding oxygen therapy. Respir Care. 2003;48:611–20.PubMedGoogle Scholar
  13. 13.
    Dinis-Ribeiro M, Vargo JJ. Sedation by non-anesthesiologists: are opioids and benzodiazepines outdated? Digestion. 2010;82:100–1.PubMedCrossRefGoogle Scholar
  14. 14.
    Coté GA. The debate for nonanesthesiologist-administered propofol sedation in endoscopy rages on: who will be the “King of Prop?”. Gastrointest Endosc. 2011;73:773–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Rex DK, Deenadayalu VP, Eid E, Imperiale TF, Walker JA, Sandhu K, Clarke AC, Hillman LC, Horiuchi A, Cohen LB, Heuss LT, Peter S, Beglinger C, Sinnott JA, Welton T, Rofail M, Subei I, Sleven R, Jordan P, Goff J, Gerstenberger PD, Munnings H, Tagle M, Sipe BW, Wehrmann T, Di Palma JA, Occhipinti KE, Barbi E, Riphaus A, Amann ST, Tohda G, McClellan T, Thueson C, Morse J, Meah N. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009;137:1229–37.PubMedCrossRefGoogle Scholar
  16. 16.
    Werner C, Smith A, Van Aken H. Guidelines on non-anaesthesiologist administration of propofol for gastrointestinal endoscopy: a double-edged sword. Eur J Anaesthesiol. 2011;28:553–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Jordan LM, Kremer M, Crawforth K, Shott S. Data-driven practice improvement: the AANA Foundation closed malpractice claims study. AANA J. 2001;69:301–11.PubMedGoogle Scholar
  19. 19.
    Bogod D. Negligence litigation and medicine: force for good or root of all evil. Anaesthesia. 2011;66:247–9.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2012

Authors and Affiliations

  • Sung-Jin Hong
    • 1
  • Yoo-Jin Kang
    • 2
  • Young-Hun Jeon
    • 3
  • Ji-Seon Son
    • 4
  • Jang-Ho Song
    • 5
  • Chan-Seon Yoo
    • 6
  • Duk-Kyung Kim
    • 6
  1. 1.Department of Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, School of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of Anesthesiology and Pain Medicine, Saint Vincent’s Hospital, School of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  3. 3.Department of Anesthesiology and Pain Medicine, School of DentistryKyungpook National UniversityDaeguRepublic of Korea
  4. 4.Department of Anesthesiology and Pain MedicineChonbuk National University Medical SchoolJeonjuRepublic of Korea
  5. 5.Department of Anesthesiology and Pain MedicineInha University School of MedicineIncheonRepublic of Korea
  6. 6.Department of Anesthesiology and Pain Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineGangnam-Gu, SeoulRepublic of Korea

Personalised recommendations